DIABETES - SPECIAL EDITION WORLD DIABETES DAY 4 NOVEMBER 2018 - diabetes singapore
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WORLD DIABETES DAY 4 NOVEMBER 2018
DIABETES
MCI (P) 033/09/2017
OCT TO DEC 2018 ISSUE 67
Singapore
SPECIAL EDITION
WORLD DIABETES DAY
4 NOVEMBER 2018
THE FAMILY & DIABETES
Together we can beat diabetes
1
CONTENTS
05
DS MESSAGE
13-15
CARE CORNER
THE FAMILY & DIABETES CURBING THE ROLLERCOASTER OF TYPE 1 DIABETES
06-11
DS BUZZ 16-17
HP’S MY COMMUNITY 2018: DIABETES AWARENESS SPECIAL FEATURE
DIABETES SINGAPORE-PENTECOST METHODIST CHURCH THE FAMILY & DIABETES
18-19
JOINT DIABETES & HEALTH TALK
PIONEER PRIMARY SCHOOL DIABETES EDUCATION TALK
OUTREACH EVENTS JUL TO SEP 2018
ANCIENT CITY TRAIL DSG WALK—FORT CANNING PARK COOKOUT
DSG WALK—CHANGI BEACH PARK SALMON & SILVER FISH FRIED RICE
COMMUNITY CHEST HEARTSTRINGS WALK GRILLED CHICKEN & PEAR WHOLEGRAIN PASTA SALAD
12 20-24
THE LIGHTER SIDE
HEARTWARE PASTA MANIA
LIFE STORIES & FAMILY MATTERS HEALTHY EATING: A FAMILY AFFAIR
25-26
SHAPE UP
BARRIERS TO EXERCISE: TOO BUSY, TOO OLD, TOO WEAK
06 12 22 25
DS management committee 2018/2020
Diabetes Singapore OCT TO DEC 2018
FOUNDER PRESIDENT HON TREASURER
Dr Frederick Tan Dr Kevin Tan Eng Kiat Ms Evelyn Hah
Bock Yam
VICE-PRESIDENTS ASST HON TREASURER
PATRON Dr Kalpana Bhaskaran Ms Juliana Lim Bee Yoke
The Honourable Dr Bee Yong Mong
Minister for Health COMMITTEE MEMBERS
HON SECRETARY Mr Yong Chiang Boon
ADVISOR Ms Esther Ng Mr Steven Seow
Dr Warren Lee Ms Maurine Lam
ASST HON SECRETARY Ms Aslena Hussain
Dr Daphne Gardner Su-Lyn
WORLD DIABETES DAY 4 NOVEMBER 2018 DS MESSAGE
editorial team
Editor-in-chief
Dr Yeo Kim Teck
The Family & Diabetes
Managing Editor
Together We Can Beat Diabetes
Charlotte Lim
The International Diabetes Federation (IDF) has designated the theme for World
Editor (Dietetics) Diabetes Day 2018 and 2019 as “The Family and Diabetes” with the message that
Ong Li Jiuen Diabetes concerns every family. How true! You would immediately think about the
financial and psycho-social impact on the family of a person who gets diabetes. This
Editorial Consultants is compounded if the person first found out he/she has diabetes through a diabetes-
DS Management Committee
related complication like a heart attack, kidney failure, lower limb amputation or
Writers even blindness (and this is not far-fetched, as half of Type 2 diabetes patients go
Henry Lew (psychologist) undiagnosed and there is a long pre-detection period during which complications
Kohila Govindaraju (nutritionist) develop). However, there are greater ramifications of the theme—family support is
Ray Loh (physiologist) crucial in helping a person deal with diabetes, perhaps more so with Type 1 diabetes—
Clare Tan (DS)
understanding of food, exercise requirements, the need to take medication and
Juliana Lim (DSG)
insulin shots on time and recognising the warning signs of hypoglycaemia in order
Contributors to intervene. Family environment (‘nurture’) is as important as genetics (‘nature’) in
Dr Matthew Tan pushing a young child or adult down the road to develop Type 2 diabetes and equally
Dr Daphne Gardner important in preventing diabetes. In a recent global Dawn2 study on diabetes, it was
Amy Wong quoted that “Diabetes is a family’s life sentence” and nothing can be more true than
Mah Wai Yee
this. In being diagnosed with diabetes, the family members who have undergone the
Concept & Design same ‘nurture’ are at risk as well and, moreover, being a lifelong condition which
Charlotte’s Web Communications requires lifestyle and diet adjustments, the whole family needs to join in this fight.
In keeping with this our tagline for this year’s World Diabetes Day is “Together We
Printing Can Beat Diabetes”.
Stamford Press Pte Ltd
Advertisement Bookings We are still in the midst of the ‘War on Diabetes’ in Singapore and this year the
T: 6842 3382 or E: editor@diabetes.org.sg battle is focused on educating on pre-diabetes and how to prevent ensuing Type 2
diabetes. The mainstay of this is of course a healthy lifestyle comprising nutrition,
For Past Issues www.diabetes.org.sg exercise and weight reduction if overweight and the family plays a great part in
DS HQ & Jurong Diabetes Education support and encouragement.
& Care Centre
Blk 528 Jurong West St 52 So mark the date for this year’s World Diabetes Day Singapore! It is on Sunday, 4
#01-353 Singapore 640528 November 2018 at Suntec City Convention Centre Level 3. It is a full-day event from
Tel : (65) 6564 9818
Fax: (65) 6564 9861 9am to 4pm, and it’s free to the public. The organising committee has lined up an
exciting program with free health screenings and special talks centring on the theme.
Central Singapore Diabetes Education
& Care Centre Come and learn or bring someone new to diabetes along. Show your support by
Blk 22 Boon Keng Road coming together with those living with diabetes. I hope to see you there.
#01-15 Singapore 330022
Tel : (65) 6398 0282 DR KEVIN TAN
Fax : (65) 6398 0275 D IABE TES
President SINGAPORE
On 25 September 1971, Dr Frederick Tan Bock Yam founded the Diabetic Society of Singapore (DSS) to help diabetes patients
manage their condition. In November 2017, DSS officially changed its name to Diabetes Singapore (DS).
DS is a non-profit organisation affiliated to the International Diabetes Federation and the National Council of Social Service. DS
gratefully accepts donations of any amount to help fight diabetes. All donations are tax-deductible. Please make cash donations
in person at any of our centres. Cheque donations should be made payable to ‘Diabetes Singapore’.
You may also make online donations via https://www.giving.sg/diabetic-society-of-singapore.
Disclaimer
The views, opinions and recommendations given by the contributors of Diabetes Singapore or are merely for general reference. All materials in this newsletter are for informational purposes only. The
individual reader should consult his own doctor or specialist for his personal treatment or other medical advice. DSS and Diabetes Singapore Editorial Board disclaim all responsibilities and liabilities for
content expressed in this newsletter including advertisements herein. All contents of the newsletter are the copyright of the contributors and newsletter. Reproduction in any form is strictly prohibited
5
unless with written permission.
DS BUZZ Clare Tan
5 SEP 2018
HP’S MY COMMUNITY 2018: DIABETES AWARENESS
D
iabetes Singapore’s collaboration with Hewlett Ms Baxi’s talk was just as insightful; she shared about how food
Packard (HP) for its My Community 2018: Diabetes helps with stress management and how our dietary habits may
Awareness event marks an important milestone for have psychological effects that can either make or break our
DS as we resume health talks at corporations. diabetes management efforts. DS also wanted to emphasise
that although work takes up a sizeable part of one’s daily life,
On 5 September, DS brought an entire line-up of diabetes we certainly need not compromise on our health. Instructors
education and care talks and program to the company as part from Vsaya Yoga led the participants on a short workout,
of its staff welfare efforts.We were pleased to have Dr Matthew demonstrating that exercise can actually be done without
Tan and Ms Ujjawala Baxi who shared their knowledge and leaving one’s office seat!
expertise with the 200 HP staff.
After the talks and workout, we refreshed ourselves with
Dr Tan’s talk consisted of in-depth case studies of past patients, healthy beverages sponsored by Nutrisoy Singapore. Diabetes
reiterating that diabetes affects each patient personally and Singapore is heartened by the success of this event, and looks
differently. Thus, a unique and personalised approach needs to forward to another event with HP in October.
be in place to prevent and manage one’s diabetes.
Diabetes Singapore OCT TO DEC 2018
6
WORLD DIABETES DAY 4 NOVEMBER 2018 DS BUZZ
Clare Tan
25 AUG & 4 SEP 2018 (English & Mandarin)
DIABETES SINGAPORE-PENTECOST METHODIST CHURCH
JOINT DIABETES & HEALTH TALK
Diabetes Singapore was honoured A separate Mandarin session
to organise its first joint event with conducted by our speaker Mdm Lai
Pentecost Methodist Church, an Yee Khim, was held on 4 September
initiative of their Outreach and Social 2018. It was attended by more
arm. than 30 members of the Chinese
congregation.
The speakers, Dr Abel Soh and Mr
For Wei Chek, focused on the topic During the tea session, 10 of our
of diabetes management with the 120 Diabetes Singapore Support Group
participants. (DSG) members got to interact with
residents in the Pasir Ris area and
Dr Soh gave advice on the importance talk about their personal journey
of being disciplined with diabetes with diabetes management, while
management instead of getting too enjoying healthy yet yummy snacks
hung up on glucose readings, while and beverages sponsored by Nutrisoy
Mr For shared very practical dietary Singapore and Sugalight.
habits.
Once again, DS would like to thank
Our committed exercise volunteer all involved organisations for helping
instructor Mr Chow Kean Pang also make this event a success, and we
led the participants with a short look forward to holding more of such
workout demonstration, to show joint events with other community
them how easy it is to be physically partners.
active.
13 SEP 2018
PIONEER PRIMARY SCHOOL Diabetes Singapore returned to Pioneer Primary School,
this time with Nurse Siti flanked by the Project Vitalize team
DIABETES EDUCATION TALK from Hwa Chong Institution. The boisterous enthusiasm of
the Pioneer Primary School children did not faze Siti and
the Hwa Chong boys and they delivered an informative and
entertaining talk on how to start diabetes management young.
Some of the information was familiar to the 200 students,
but there was still new knowledge to glean. During quiz time
the lower primary students still had some misconceptions
about the nature of carbohydrates and sugar. Also, there was
a considerable uproar when Nurse Siti touched on sufficient
sleep as a key component in stress management, appealing to
all to get more rest and reduce time spent on social media in
the wee hours of the night.
Diabetes Singapore hopes to be able to engage more young
people in our efforts to educate and mobilise everyone to
7
adopt a healthy lifestyle.
DS BUZZ Clare Tan DS OUTREACH EVENTS JUL TO SEP 2018 22 JUL HINDU ENDOWMENT BOARD HEALTH FESTIVAL 2018 Diabetes Singapore believes in supporting the efforts of any organisation that desires to promote healthy lifestyle management. So, we took part in the Hindu Endowment Board Health Festival 2018, where our Executive Director Mr Venkatesh Narasiah discussed with Guest-of-Honour Minister Indranee Rajah, Diabetes Singapore’s efforts to promote healthy living among the Indians in the community. 26 AUG SATA COMMUNITY HEALTH DAY At the SATA Community Health Day held at its Tanjong Pagar clinic, our speaker Mdm Lai Yee Khim engaged the 60 participants present at her talk. She reinforced the importance of disciplined diabetes care and management after having regular health screening session; many in the audience expressed interest in wanting to learn more about this through our upcoming preventive diabetes care course. 9 SEP ENG CHOON HWAY KWAN (SINGAPORE) MEDICAL SHARING FORUM DS also participated in Eng Choon Hway Kwan (Singapore)’s Medical Sharing Forum. Staff nurse Anni Lek provided health screening services for members of the Eng Choon clan community, while our DS exco member Mr Yong Chiang Boon had the opportunity to share with Guest-of- Honour Minister Gan Kim Yong how Diabetes Singapore has been actively supporting grassroot and clan organisation for public health awareness. Diabetes Singapore values outreach events such as these to raise public awareness and action towards prediabetes care and management in daily life. DS would like to thank all organisations who have provided us with opportunities to bring about change in the way Singaporeans view preventive health management. 8
WORLD DIABETES DAY 4 NOVEMBER 2018 DS BUZZ
Juliana Lim
30 JUN 2018
ANCIENT CITY TRAIL DSG WALK
FORT CANNING PARK
On a sunny and windy Saturday afternoon, 34 enthusiastic
walk participants gathered at Dhoby Ghaut MRT Passenger
Service (North-South Line) way before the scheduled
3.30pm meeting time.
The walk started at 3.45pm and the pre-walk Blood Glucose
testing was taken midway along the tunnel, after which we
walked towards the park.
Kean, the exercise trainer from “HappyFit”, once again joined
us for our walk. He started us on some good stretching
exercises, beginning with warm-ups and ending with cooling
down exercises for 20 minutes in the open space at the
front of Fort Canning Arts Centre. The happy faces of the
participants showed that all enjoyed the exercise session
with a promise by Kean to join us for future DSG walks.
Venky and Clare from Diabetes Singapore shared about
volunteering and DS’s collaborations with Ng Teng Fong
General Hospital (NTFGH) and Hewlett Packard (HP). The
members gave a show of their support for the upcoming
events. Two more members signed up to join the pilot
launch of the volunteering program with NTFGH, yielding
a total of 12 DSG members and four non-DSG members!
The walk continued and just before ending the walk at the
2km mark, we had our post-walk Blood Glucose testing
taken at a shady spot. Finally we all walked through the
tunnel leading back to Penang Road‘s bus stop, where a few
members decided to take the bus home.The rest proceeded
to Dhoby Ghaut MRT station, reaching at about 6.30pm.
Most participants adjourned for dinner at Kopitiam (level
six) in Plaza Singapura while the rest returned home.
9
DS BUZZ
Juliana Lim
28 JUL 2018
DSG WALK
CHANGI BEACH PARK
Our walk in Changi Beach Park was great as the weather was
windy albeit sunny. All registered participants had assembled
at Tampines East MRT’s Passenger Service Area from as early
as 3.15pm. At 3.30pm, pre-walk blood glucose readings were
taken by Christine Lee and recorded by Michael Lee.
At around 4pm, we boarded bus No. 9 for the 20-minute
journey to the designated point at Changi Beach Park CP 2
where Kean, Syed and Maureen had arranged to meet us. A
Before our walk started at around 5pm, Juliana announced
quick pre-walk blood glucose reading was taken for Maureen
that Kean had decided to commit himself to join us on
and recorded for Syed who had taken his own reading.
subsequent DSG walks.The members were greatly heartened
and all cheered upon hearing this piece of good news!
Everyone walked at a brisk and even pace. Various sharings
were done during the walk with participants exchanging
concerns and suggestions on how to improve the blood
glucose readings.
A group photo session was soon taken by our avid
photographer,Tan Hwee Leng, at a scenic spot. Following this,
Kean took us through a 20-minute energetic exercise session,
conducted in an open green space facing the sea.
The walk continued up to the 4km mark; then we walked
back to Changi Village. However, a lovely shady and windy
spot with natural seats made of wooden logs was sighted by
some members near Changi Beach Park CP 1. We decided
to take the post-walk blood glucose readings there before
heading to the Hawker Centre for a well-earned dinner.
Diabetes Singapore OCT TO DEC 2018
The walk covered a total distance of 4.47km, ending at
6.30pm with many feeling refreshed after a good walk, a good
stretch and great company.All these contributed to improved
blood glucose readings. After that, most of us adjourned to
have dinner at Changi Village Food Centre.
DSG wishes to thank all DSG Assistant Leaders, Kean, our
dedicated exercise trainer, and Diabetes Singapore for their
support.
10 Lilly Centre for Clinical Pharmacology Pte Ltd
3 Biopolis Drive
#02-11, Synapse
Singapore 138623
DS BUZZ
WORLD DIABETES DAY 4 NOVEMBER 2018 DS BUZZ
Clare Tan Juliana Lim
25 AUG 2018
COMMUNITY CHEST HEARTSTRINGS WALK
Once again members of Diabetes Singapore participated in up exercise before he and the organisers flagged off the Fun
the Community Chest Heartstrings Walk 2018, held on 25 Walk. The 4km walk route started at Crystal Pavilion South
August at the Marina Bay Sands. Our group of cheerful DSG and ended at Crystal Pavilion North.
members in blue T-shirts turned up between 7.00 and 7.15am,
assembling at Bayfront MRT Station’s Exit D, where the Fun Our DSG members joined in the Fun Walk of 4km with great
Walk Kits (collected by Juliana a week earlier) were distributed enthusiasm; we enjoyed a wonderful time of bonding and unity.
to each person. At 7.45am we tagged along the various groups The brisk Fun Walk lasted approximately an hour, ending at
from different organisations and walked towards the Event 9.15am. Along the way, members broke into different groups,
Plaza for the start of the event. chatted and enjoyed each other’s company, taking group
photos, as well as taking in the Marina Bayfront scenery.
A large crowd of 8,000 participants was already there, enjoying
the pulsating music and games in the carnival-like atmosphere. At the finishing line, our members joined the long queue
The Master of Ceremony encouraged everyone to gather to redeem goodies bags from the redemption booth. With
closer to the stage as he prepared to welcome the Guest- satisfied smiles and flushed faces, some members dispersed at
of-Honour, Mr Teo Chee Hean, Singapore’s Deputy Prime around 9.45am. Some stayed behind for the lucky draw results.
Minister and Coordinating Minister for National Security.
Following his opening speech, we all joined him in the warm
11
HEARTWARE
Henry Lew
LIFE STORIES &
FAMILY MATTERS
Mdm Farida stared at the blood sugar levels results. to her. Love also meant taking care of her own health and
She was shocked that her glucose level had gone up her family. Perhaps she could be a good role model for her
children and start cooking healthier meals for her family?
again. She wanted to do something, but felt trapped.
Mdm Farida had been hesitant about cooking At that moment, Mdm Farida’s eldest son walked into the
healthier foods because she was afraid that by kitchen to see his mum looking despondent. He was aware
her family members would not welcome her new of Mdm Farida’s dilemma and his younger siblings preference
menu. They looked forward to the meals she always for fried food. He said, “Ibu, we are all older now and we have
prepared for them and did not want to disappoint been taught to eat healthy in school as well. It’s true that we
them. She thought of increasing her physical activity. like fried food and the younger ones may complain, but if we
know we are doing it for you, we are willing to try as well”.
However, the daily load of household chores tired
Such comforting words! Mdm Farida was delighted that she
her out every day and she just could not find the was not alone and her family was prepared to journey with
energy and time to exercise. her.
Family means a lot to Mdm Farida. She wants to be healthy Mdm Farida’s experience may be familiar to us. Often we feel
so that she can continue to take care of her family. It is clear alone in our journey towards achieving better health. We do
to her that in her current state of health, she does not have not want to burden our family. Unknown to us, our family may
the stamina to engage in more activities with her children. be more than willing to help. Furthermore, once we start to
She certainly does not want her condition to limit her lead a healthier life, it will have a ripple effect on our family
children. Neither does she want to end up with more health members, and everyone benefits from eating and staying
complications. healthy.
As Mdm Farida pondered over her next steps, she realised that Within each of us is a wealth of experience, what we would
she was not alone. People had cheered her on to achieve her call our ‘life stories’.These life stories are like hidden treasures.
health goals before. She recalled cooking a healthier dish and In Mdm Farida’s case, there were instances, even though rare,
her children loved it. She remembered watching some cooking where she was able to engage the younger children to eat
program on television about healthier dishes that tasted good healthier food. These experiences helped her to generate
further solutions.
Diabetes Singapore OCT TO DEC 2018
as well. She had even discussed the recipe with her doctors
and dietitian and they had given her more ideas. Her friends
had even asked her for the recipes. From there, she was reminded of other positive experiences
and encounters with others, such as her mother, her friends
Mdm Farida is a food lover and loves to prepare food for her and her doctors who have helped her to clarify what she
family. It give her satisfaction to see them happy and satisfied values most in life and how she can generate solutions from
during a meal. Her mother and grandmother had taught her there.
a lot about cooking. Food means tradition, love and interest
About the author: Henry Lew works as a psychologist and enjoys coming up with creative ways to engage his patients and
readers.
12WORLD DIABETES DAY 4 NOVEMBER 2018 CARE CORNER
Dr Daphne Gardner
CURBING T HE roller coaster
OF T YPE 1 DIABET ES
Individuals with type 1 diabetes have The Singapore Dose Adjustment For
no insulin production and are wholly Normal Eating (SgDAFNE) Programme
dependent on injected insulin to maintain is currently in the seventh year of running,
normal glucose levels. For those living and seeks to provide education in self-
with Type 1 diabetes, glucose management management and advanced carbohydrate
involves negotiating a tightrope between counting in a group setting for those with
high and low glucose levels, often resulting Type 1 diabetes.
in confusion and frustration.
In delivering a standardised comprehensive
The previous mantra of leading regimented curriculum which covers topics ranging
lifestyles with dietary restrictions and fixed from blood glucose targets to glucose
insulin doses in order to achieve stable management during sick days or exercise,
glucose control should no longer have SgDAFNE has seen through 20 groups
a role in contemporary Type 1 diabetes with Type 1 diabetes, with noticeable
management. improvements in glucose control alongside
reduced insulin doses.
13CARE CORNER
Each SgDAFNE programme spans over five days (typically decisions on insulin doses based on the blood glucose levels,
over the weekends to allow less time taken off work/school) carbohydrate intake and the level of activity daily. Blood
and accepts all Type 1 diabetes individuals across the island glucose records move from being merely a report card for the
above the age of 18 years into the programme. Each course healthcare providers’ viewing towards meaningful numbers to
is also followed up with three group review sessions within guide insulin dose titration. For example, knowledge about
the year, to reinforce learning points and to discuss practical safe bedtime blood glucose targets, and interpretation of
challenges in the ‘real world setting’. Carbohydrate is the main overnight glucose readings allows self-management practices
macronutrient resulting in post-meal rises in glucose levels. such as consuming carbohydrates or reducing basal insulin
Counting carbohydrates (estimating carbohydrate content doses to prevent nocturnal hypoglycaemia.
to guide insulin dosing) remains an important component in
self-management, particularly in Asia, where cultural influences To illustrate these points above, here is the retrospective
in cooking styles and eating habits may present difficulties in (blinded) continuous glucose monitoring sensor tracing of a
the form of ‘hidden carbohydrates’, ‘grazing through the day’ 20-year-old man (Mr T) who has had Type 1 diabetes since
or ‘love for buffets’. Locally relevant food plates and dietary he was seven years old (Figure 1). His HbA1c at the time
information therefore becomes crucial in delivering SgDAFNE of doing this tracing was 8.1% and he hadn’t been taking
and to date, we remain the only DAFNE centre in Asia. capillary blood glucose readings regularly. His insulin doses
were high with a total daily dose of 59 units (0.92u/kg/day)
Counting carbohydrates aside, learning about blood glucose and skewed towards his bolus doses (background insulin 15
targets, why the highs and lows happen and how to pre-empt units at bedtime, 8/18/18 (total 44 units) quick acting insulin
these, are integral components in self-management. After all, at mealtimes).These tended to be fixed doses which were not
besides the three to four healthcare provider visits a year, changed regardless of the amount of carbohydrate intake.
every type 1 diabetes individual will have to make multiple
The pre-DAFNE CGMS tracing in 2014 demonstrated much variability with his glucose readings with episodes of nocturnal
hypoglycaemia overnight. There was often post-meal hyperglycaemia (high glucose levels) with each meal, and towards the
evening. At the end of 2014, Mr T attended the SgDAFNE programme. In learning to accurately count his carbohydrates and
interpreting his own glucose levels, it became clear to Mr T that his background insulin was not lasting the duration of the 24
hours and he needed twice daily background insulin dosing. Increasing and splitting the background insulin dose to twice daily
enabled him to reduce the use of quick-acting insulin boluses during the day.
Diabetes Singapore OCT TO DEC 2018
Over the next four years following the DAFNE course, Mr T has maintained a HbA1c level of 7 to 7.4%. He has achieved this
on split background insulin doses (11 units in the morning, seven in the evening) and much reduced doses of quick acting insulin
according to his carbohydrate intake (on average eight units with each meal, total daily dose 42 units of insulin or 0.66 units/kg/
day). This was significantly lower than his pre-DAFNE dose of 59 units/day. His CGMS tracing two years post SgDAFNE (figure
2 on next page) demonstrated much less glycaemic variability (particularly after meals suggesting better carbohydrate counting
skills) and importantly, minimal hypoglycaemia.
14WORLD DIABETES DAY 4 NOVEMBER 2018
This very much demonstrates the importance of knowledge into problem solving from peers can help in overcoming life
in advanced carbohydrate counting and self-management in challenges. Currently still supported by Sanofi and Abbott
those with Type 1 diabetes. It also clearly shows that it is the Laboratories (for glucometers), we welcome enquiries, from
quality rather than the quantity of insulin use that matters. those with Type 1 diabetes themselves, at the following email
address: gsodia@sgh.com.sg. Dates for SgDAFNE programme
In these seven years, we have learnt from and alongside many, for the year, and any Type 1 diabetes-related events are posted
the struggles and challenges of living with Type 1 diabetes in on SgDAFNE facebook. A pre-assessment is required prior to
Singapore or Asia. In Asia, mealtimes are often communal, the programme, to assess aetiology, insulin doses and dietary
social activities shared between family members or friends. knowledge. That aside, all it takes to attend is a desire to be
Checking blood glucose levels, counting carbohydrates and self-empowered and take control.
taking the insulin pen out for injections may invite awkward
conversations or stares. The regular snacking culture which is
part of the office tea-time activity is not one that those with
Type 1 diabetes can easily take part in since any carbohydrate
snacks without insulin cover shows up in a higher HbA1c level.
Activities that those without Type 1 diabetes take for granted
e.g. unplanned exercise, consuming alcohol, school sports
activities, often need forward planning in Type 1 diabetes, with
either insulin dose reduction or topping up of carbohydrates
to prevent hypoglycaemia.
Where does SgDAFNE go from here? From a lean team of just
three DAFNE accredited educators consisting of a diabetes
nurse educator, dietitian and endocrinologist, we have now
expanded to a team of four diabetes nurse educators, six
dietitians and three endocrinologists who are now aligned
and familiar with intensive insulin therapy and insulin dose
titration in type 1 diabetes.This has enabled the incorporation
of diabetes technology such as real-time continuous or flash
glucose monitoring and insulin pump therapy in order to
improve flexibility, quality of life and ultimately outcomes for
those with Type 1 diabetes. About the Author: Dr Daphne Gardner is a senior consultant with
the Department of Endocrinology, Singapore General Hospital.
SgDAFNE remains committed to empowering those with Graduating from Oxford University, United Kingdom, she did part
Type 1 diabetes with knowledge and skills to gain control of her specialty training in Plymouth (Devon) and attained her AST
over glucose management during physical activity, sick days in Endocrinology in 2011. Dr Gardner’s main interests are in young
and other unpredictable life circumstances, whilst allowing individuals with diabetes, including type 1 diabetes incorporating
flexibility in dietary choices. We recognise that life isn’t all education and technology, monogenic diabetes and transition
about glucose management; having support and gaining insight services.
15SPECIAL FEATURE
Dr Matthew Tan
T HE
FAMILY
&
“It runs in your family…” These dreaded words seem like a death sentence, when doctors use it to
explain how a chronic disease like diabetes mellitus may develop more easily in susceptible
DIABET ES
individuals. Studies have suggested that having a positive family history for diabetes mellitus
increases the personal risk of developing prediabetes and diabetes. The more family members
involved, particularly first degree relatives, the higher the risk, which ranges from two times to more
than six times the baseline risk of individuals who do not possess a family history of diabetes
“It runs in your family…” But perhaps one could swing from The usual questions “Is my pancreas
mellitus.
negative pessimism to one of cautious failing?”, “If I abstain from all sugar from
These But perhaps
dreaded you could words
change the lens from
optimism thatone of negative
a positive familypessimism,
history to nowoneon,ofcan
cautious
I reverse optimism
diabetes?”—a long
seem like
that a death
having sentence,
a positive family history is like an early warning system for the storm of
can act like an early warning system for list, understandably, from a very anxious diabetes
when approaching.
doctors Ituse wouldthem
be prudentan to
approaching
heed suchdiabetes
a warning storm. It would
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early much be canpossible to run a host of
to explain how a chronic and go for health evaluation, and if we tests and investigations to
diabetes earlier perhaps more be done
change the course of the disease and improve the outcome for the patient. Let me illustrate this estimate to
diseasewith a recent
like case.diabetes can detect pre-diabetes or diabetes at the individual’s insulin sensitivity or
mellitus may develop an earlier stage, perhaps much more can insulin resistance and pancreatic beta
more Aher young woman in her early 30s
easily in susceptible be
risk of developing diabetes disease
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Scrutinising history
her health screening
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young woman done last year,early
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achieved forwith
her concern. Her
lifestyle changes alone
for fasting
diabetes mellitus
glucose and also glycated haemoglobin (Hba1c) were elevated
consulted me recently as she was without medications? and despite the absence of
increases thesymptoms,
diabetes personal risk
it was clearnow
that getting
she wasanxious
likely developing
about her diabetes.
risk of
of developing prediabetes
The usual questions
developing diabetes mellitus. Her mother Arguably one of the best ways forward
“Is my pancreas failing?”, “If I abstain from all sugar from now on, can I reverse
had suffered from diabetes mellitus, and is to first help the patient understand
and diabetes.
diabetes?” etc- Thea long morelist, understandably, from a very anxious individual. From a research
had passed away from complications that diabetes is not a static number that
family members involved, relating
standpoint, it would be possible to run a host of tests and investigations to estimate the individual’s
to the disease. It was clear that is represented merely by a single glucose
insulin sensitivity or insulin resistance and pancreatic beta cell function. However, frominathe more
particularly first degree she hoped to avoid the same
pragmatic perspective, the actionable point would be what can the individual
fate. reading
do
done early
now to lower
morning, and
blood
in the fasted state. As we can see in the
relatives,
glucosethe levelshigher the levels?
to non-diabetic And her
Scrutinising can health
it be achieved
screening withreportlifestyle
graphschanges
below alone
and on without
the next page,
risk, which
medications? ranges from done last year, I could see grounds for her glucose readings do have upswings
two times
Arguablyto onemore
of the bestthan her concern. Her fasting glucose and corresponding to periods of eating. It
way forward is to first help the patient understand that diabetes is not a
six times
staticthe
number baseline risk alsomerely
that is represented
glycated haemoglobin (HbA1c) was clear that late night suppers and
by a single glucose reading done early in the morning, and
Diabetes Singapore OCT TO DEC 2018
were elevated and despite the absence eating carbohydrate-rich food did have
of individuals who do not of diabetes symptoms,
in the fasted state. As we can see in the graphs below, her glucose readings do have upswings
it was clear that a significant impact on her glucose
possesscorresponding
a family to periods of
history ofeating. It was
she was clear
likely that latediabetes.
developing night supper and eating carbohydrates-rich
readings with rather slow recovery
food did have a significant impact on her glucose readings with rather slow recovery hours later.
diabetes mellitus. hours later.
16 The silver lining in this case is that overall, her glucose readings are a lot less serious than what lastWORLD DIABETES
The silver DAY
lining in this case4isNOVEMBER 2018
that overall, her glucose readings are a lot less serious than what last
The silver lining in this case is that overall, her glucose readings to help him understand this new way of life where injecting
are a lot less serious than what last year’s health screening insulin should be as automatic as brushing teeth or eating
would suggest, and making healthy lifestyle adjustments would a meal. To add to the complexity of the management, his
probably be sufficient intervention at this point in time. wife is also struggling with a severe medical ailment herself,
Regular health check-ups and follow-ups would be prudent and currently needs help with all her basic needs including
to reassess her progress. Although diabetes mellitus is in toileting. This adds to the physical and mental toll on my
her genes, a negative outcome is not a foregone conclusion. patient, which contributes to the wide fluctuations seen in his
A healthy, long, complication-free life is still possible because glucose readings.
the knowledge she has from her family history enables her
to make the right lifestyle choices today that will have a great The tricky part is the decision that has to be made every meal.
impact on her future. “How much insulin to inject?” It is really different depending
on whether the meal is going to be rice or noodles, or chapati,
FAMILY TIES THAT BIND
year’s health screening would suggest, and making healthy or simply salad.adjustments
lifestyle Sometimes would it is difficult
probablywhen beeating outside
Studies sufficient
suggest that patients are more likely to adhere and everything is jumbled
intervention at this point in time. Regular health check-ups and follow-ups would be up like rojak or gado gado—a mix of
to treatment
prudent if they have close
to reassess support from
her progress. Althoughtheirdiabetes
family. mellitus
vegetables,is incarbohydrates
her genes, a and sauces.outcome
negative To make is matters worse,
Conversely,
not afamilies
foregone in conflict may Apresent
conclusion. healthy,a barrier to it is a lot different
long, complication-free life is when the patient
still possible is under
because stress, having a
the
treatment adherence.
knowledge sheFamily members
has from can play
her family an important
history enables hermigraine
to makeheadache
the rightor when he
lifestyle just had
choices a football
today that session—all
part in will
thehavemanagement of diabetes.
a great impact on her future.There is evidence of these factors can completely change his insulin needs.
for improvement in patients’ self-efficacy, perceived social
support, patients’ understanding of the disease and ability to Fortunately, he has strong support from his children, who
self-manage with the disease. Family support is even more despite their busy schedules, would make time to support him
Family ties that bind
important for patients who have challenging diabetes to treat in the clinic visits. It is always heartwarming to see them rally
as we can see insuggest
Studies the nextthat example.
patients are more likely to adherebehind their father
to treatment if theyand havecommit
close to sharedfrom
support decisions on his
their family. Conversely, families in conflict may present treatment,
a barrier as toa cohesive
treatment family unit. ThisFamily
adherence. is essential, as the
A middle-aged
members mancan in hisplay
mid-50s has been consulting
an important part in the me for day to dayofhandling
management diabetes. of insulin
There and matching for
is evidence of insulin to the
Type 1 diabetes mellitus. He was unusual in that the disease
improvement in patients’ self-efficacy, perceived social support, patients’ understanding of theoverwhelming.
amount of carbohydrates consumed can be
only manifested
disease when he wasto50self-manage
and ability years old, and notthe
with earlier in With
disease. Family close support
support is from
even his morefamily members,for
important various aspects
life which is typical of Type 1 diabetics. He does not have a of diabetes
patients who have challenging diabetes to treat as we can see in the next example. care can be shared including meal planning, family
family history of diabetes mellitus. activities and looking out for him during sick days.
A middle aged man in his mid-50s has been consulting me for Type 1 diabetes mellitus. He was
unusual
As you can in that
see from thethe disease
graph below,only manifested
his readings are when he was
volatile, 50 years diabetes
In summary, old, and isnot earlierdisease.
a family in life which is be tackled as
It has to
swingingtypical
from of lowType to 1markedly
diabetics.high
He does not have
readings a family
within the history
a familyofbecause
diabetes mellitus.
it does run in the family due to genetic factors
same day. His type of diabetes requires insulin for survival, and is influenced by shared environment. Family support is
As you can see from the graph, his readings are volatile, swinging from low to markedly high
and typically he needs at least four insulin injections per day. also an important pillar in diabetes management, and its role
However, readings
it has within
been athe realsame day. and formidable task in optimal diabetes care cannot be underestimated.
challenge
References
Meigs JB, Cupples LA, Wilson PW. Parental transmission of type 2 diabetes: the Framingham Offspring Study. Diabetes. 2000 Dec;49(12):2201-7.
Robert Wagner Hiset type ofhistory
al. Family diabetes requires
of diabetes insulin
is associated for survival,
with higher and typically
risk for prediabetes: heanalysis
a multicentre needs atthe
from least four
German insulin
Center injections
for Diabetes Research. Diabetologia, 2013
Tricia A Miller, M Robin DiMatteo Importance of family/social support and impact on adherence to diabetic therapy Diabetes Metab Syndr Obes. 2013; 6: 421–426
per day. However, it has been a real challenge and formidable task to help him understand
Baig AA, Benitez A, Quinn MT, Burnet DL. Family interventions to improve diabetes outcomes for adults. Ann N Y Acad Sci. 2015 Sep;1353:89-112 this new
way of life where injecting insulin should be as automatic as brushing teeth or eating a meal. To add
About the author: Dr Matthew Tan is Medical Director and Consultant Endocrinologist at Dr Matthew Tan Diabetes and Endocrine Care.
to the complexity of the management, his wife is also struggling with a severe medical ailment
His clinical interests include diabetes mellitus, thyroid, general endocrinology and sub-specialty interests in osteoporosis and calcium
disorders. herself, and currently
jogging needs help with all her basic needs including toileting. This adds to the
17
Dr Tan also enjoys and spending time with his two daughters.
physical and mental toll on my patient, which contributes to the wide fluctuations seen in his
glucose readings.COOKOUT
SPECIAL FEATURE
Amy Vong
Bonnie Lau
Salmon & Silver Fish
Fried Rice
SERVES 4
Ingredients Nutrition Information Per Bowl
200g Salmon Energy 293kcal
2 whole Eggs (medium) Carbohydrate 26g
15g Silver fish (small) Protein 18g
Fat 13g
200g Mixed vegetables (drained) Saturated fat 2g
240g White rice (raw) Cholesterol 112.7mg
60g Wholegrain brown rice (raw) Dietary Fibre 2.7g
10g Chopped spring onions Sodium 369mg
10g Minced garlic
6 teaspoons Sunflower oil
2 teaspoons Low salt soya sauce
¼ tsp Salt
¼ tsp Black pepper
Method of Preparation
1. Rinse and mix raw brown rice with raw white rice. Cook rice with 1.5 cups of water in rice cooker.
2. Season salmon with a pinch of salt and black pepper.
3. Heat up a non-stick pan, add 1 teaspoon oil and pan-fry salmon until light brown. Remove salmon from pan and
use a fork to break it up into flakes.
4. Add 1 teaspoon of oil to the non-stick pan, stir-fry washed silver fish until brown and set aside.
Diabetes Singapore OCT TO DEC 2018
5. In the same pan, stir fry lightly beaten eggs until cooked and set aside.
6. Pour the remaining cooking oil into the pan and fry garlic until slightly brown. Add in mixed vegetables and
loosen the cooked rice while stir-frying all the ingredients.
7. Toss in silver fish, fried eggs, salmon flakes and add in low salt soya sauce, mix all ingredients well.
8. Garnish the cooked fried rice with chopped spring onions before serving.
About the author: Amy Vong is a freelance dietitian and is currently running a small food business that caters to school age children. She
worked as a clinical and foodservice dietitian previously and is a registered dietitian (UK) for 18 years. She is passionate about promoting
health through preparing delicious and nourishing meals for people of all ages.
18WORLD DIABETES DAY 4 NOVEMBER 2018 COOKOUT
Amy Vong
Amy Vong
Grilled Chicken & Pear
Wholegrain Pasta Salad
SERVES 4
Ingredients Nutrition Information Per Serving
To make grilled
: chicken Energy 317kcal
200g Chicken thigh (skinless) Carbohydrate 30g
½ Fresh lemon (squeeze out juice) Protein 15.5g
¼ tsp Salt
Fat 15g
Saturated fat 2.3g
¼ tsp Black pepper Cholesterol 41.5mg
10 g Garlic (finely chopped) Dietary Fibre 7.0g
2 tsp Olive oil Sodium 264mg
To make salad:
100g Wholegrain spiral fusilli pasta
2 Whole Pears (diced into small cubes)
20g Walnuts (crushed)
20g Purple onions (finely diced)
100g Celery (diced into small pieces)
6-8 tsp Olive oil
2 tbsp Balsamic vinegar
1 Sprig Parsley (finely chopped)
Method of preparation
1. Marinate chicken thigh with fresh lemon juice, salt, black pepper, chopped garlic and olive oil. Cover and keep in fridge
for at least 30 minutes.
2. Pre-heat oven or air-fryer at 1800C. Grill chicken in oven or air-fryer at 1800C for approximately 15 to 20 minutes.
Leave the grilled chicken to cool before shredding into bite-sized pieces.
3. Cook wholegrain spiral fusilli pasta in boiling water with a pinch of salt and 1 teaspoon of olive oil in it until al-dente
(approximately 5 to 8 minutes according to instructions on package); drain and set pasta aside to cool.
4. Combine pasta and shredded chicken in a salad bowl. Toss with diced pears, diced celery, crushed walnuts, finely
chopped parsley, balsamic vinegar and olive oil.
5. Keep pasta salad in fridge to chill before serving.
19THE LIGHTER SIDE
Kohila Govindaraju
PASTA MANIA
Pasta is an excellent source of carbohydrate food
that provides glucose, the fuel vital for brain and
muscles. It releases the glucose gradually in the
blood, which helps prevent sugar and insulin spikes.
Pasta has a low glycaemic index (GI), which means a
slower rate of digestion and is more helpful for appetite
control. If you are looking for a quick and good meal to
satisfy your cravings, pasta is an excellent choice.
Gluten, a protein, gives the pasta its chewy texture. Wheat,
Rye, and Bulgur are good sources of gluten. Gluten helps reduce
the risk of Type 2 diabetes, heart disease and colon cancer. For
people who are not able to consume gluten due to intolerance or
allergies, gluten-free pastas are available in some supermarkets and
taste just as good.
Pasta is also a good source of folate and carotenoids—lutein and
zeaxanthin. Folate plays a major role in red blood cell formation and
carotenoids are nutrients for eye health.
Refined, enriched pasta, along with carbohydrate, contains B vitamins
and iron but is lower in fibre. Go for wholemeal pasta instead and
always consume the right portion size that helps maintain the blood
sugar level. A cup of wholegrain pasta contains approximately 4g
of fibre, while a cup of refined pasta contains only 2g of fibre.
Wholegrain pasta also contains magnesium and selenium.
Magnesium helps to metabolise the carbohydrate and selenium is
a powerful antioxidant that protects cells from free radicals.
Enjoy your pasta al dente, or firm to bite, to keep you full
for longer and for slower digestion. Half a cup cooked pasta
with lean protein, green, red and yellow vegetables is ideal
to maintain the energy level. Pasta with ground chicken or
beef, roasted bell pepper, broccoli, basil, cherry tomatoes,
and a pinch of chilli flakes will make a well-balanced
and colourful meal. Protein-packed pasta is the perfect
post-workout meal. Pasta with chicken, peas and
Diabetes Singapore OCT TO DEC 2018
vegetables will stimulate the protein synthesis, improve
recovery and enhance the performance during the
next workout. Try out the Grilled Chicken & Pear
Wholegrain Pasta Salad recipe on Page 19 by Amy
Vong!
About the author: Kohila Govindaraju is an accredited nutritionist and director of
THE BERRIES Nutrition Consulting, an avid blogger (kohilag.wordpress.com) and
prolific author of magazine articles on food and nutrition, including a book titled
How to Lose Weight Without Hunger published by PatientsEngage.
20THE LIGHTER SIDE Mah Wai Yee
HEALT HY EAT ING
A Family Affair
Diabetes is a challenging disease that can also affect the entire family in many ways.
When one is dealing with diabetes, the entire family deals with it too. Diabetes care is a family
affair as it will involve getting support from the family.
Diabetes Singapore OCT TO DEC 2018
Family involvement is very important for someone with diabetes to cope with their daily self-
care activities and to prevent diabetes complications in the long run.
Good family support can also empower a person with diabetes, and helps provide social and
emotional support. In fact, family support is key factor in diabetes care; as it has been said, “It’s
hard to do diabetes alone.”
22WORLD DIABETES DAY 4 NOVEMBER 2018
GETTING SUPPORT
If you have diabetes, it is not always easy to bring your family
on board with your new behaviours. Here are some tips and
ways you can involve your loved ones to manage diabetes
together:
1 Help your family understand the factors that
contribute to diabetes and how it is being managed
or treated. As genetics influence the likelihood of
developing diabetes, particularly Type 2 diabetes, your
family members may also benefit from following your
lead and making healthier choices as well.
2 Make small changes and allow time for your family to
get accustomed to any changes.
3 Help them to understand that people with diabetes
do not need special foods or diet; in fact, the foods you
eat to stay healthy with diabetes are generally suitable
for the entire family to remain healthy too.
4 Describe how your eating schedule may be different
from others and share tips on portion control and
healthier eating with your family.
5 Explore new recipes and prepare healthier meals
together.
6 Include your family members in food shopping and
learn to choose healthier alternatives together.
7 Find fun activities to do together for family events
as gatherings do not have to revolve around food and
eating. Engaging in other activities can help get you and
your family members to become more active.
GIVING SUPPORT
If you have a family member who has diabetes and is attempting
to make changes, you can help him/her by:
1 Encouraging him or her to be proactive in their efforts
to make changes to their diet.
2 Making lifestyle changes together to show support.
3 Offering healthy food options or preparing healthier
meals at home.
4 Making exercise part of the family routine and
participate in physical activities together
23THE LIGHTER SIDE Mah Wai Yee
(CONT’D FROM PAGE 23)
TIPS FOR FAMILY GATHERINGS • Keep yourself hydrated by choosing low-calorie thirst
Family get-togethers especially during the festive seasons can be quenchers such as water and diet soft drinks. If you
a time of great anxiety for most people dealing with diabetes as have to take alcohol, make sure that you do not drink
the focus is often on food and eating. However, festive meals and on an empty stomach and remember to limit to just
traditions do not have to disrupt your diabetes control. With one alcoholic drink–e.g. one can of beer, half glass
preparation and advance planning, a person with diabetes can (100ml) of wine or one nip (30ml) of hard liquor.
face any holiday head-on, fend off stress, and still enjoy family
meals to keep their diabetes management on track. It is not • A balanced meal with vegetables is important.
unusual for families to eat large meals at odd times. For example, Unfortunately, the vegetable selection on festive
Christmas meals may be served in the middle of the afternoon. menus is usually limited. Offer to bring a green salad
Plan in advance so that you can schedule festive meals around or a side of steamed vegetables to the gatherings.
your usual meal times. Eating vegetables add fibre (bulk) to the meal and
keeps you full to prevent overeating.
• Be open about your diagnosis and your diet and lifestyle.
Inform your extended family members ahead and let • If you are hosting a festive meal, make sure the menu
them know about your condition, dietary or meal includes healthy food choices such as fruits, vegetables
requirements so that they may plan in advance the festive and lean meats. Avoid adding extra oil in your
menu to include healthier food choices. cooking by preparing the food using healthier cooking
methods such as baking, grilling, microwaving and
• Adjust your usual meal portions and do not be tempted experimenting with lower fat recipes. It is important
to skip meals to compensate for the large festive meal. to show support to the family member with diabetes
Eat a smaller meal portion or snack before you leave by not encouraging him/her to binge eat.
home. If you arrive to the gathering/ party hungry, you
will be more likely to overindulge. • The best way to compensate for eating a little more
than usual is to be active. Find time to exercise
• If you are on insulin injections or taking a pill that lowers and maintain your usual exercise routine. Consider
blood glucose levels, you may need to have a light snack including fun family activities during these get-
at your usual meal time to prevent a low blood sugar togethers that will get people away from sitting and
level if meal time is delayed at the family gatherings. If you eating. Encourage others to move before or after the
are unsure whether you should be having a snack, please meal. Fun activities may include taking a walk, dancing
consult your dietitian on this. or playing active games such as dodge ball, hula hoop,
etc.
• Do not feel like you have to sample everything on the
table. Have a reasonable portion of your favourite foods Life with diabetes can be challenging, but when you are
and pass on the rest. If you really want to try everything, surrounded by people who love and care for you, it can be
make your portions smaller so that you try to keep less stressful and this can help a person with diabetes be
your total carbohydrate intake with the recommended more successful with his or her diabetes control.
allowance.
About the author: Mah Wai Yee is an Accredited Dietitian of Singapore (ADS) and is the Principal Dietitian at Farrer Park Hospital. She has
special interests in weight management and eating disorders. Over the course of her career, Wai Yee has contributed nutrition articles to
magazines and newspapers and conducted many nutrition talks and workshops.
24WORLD DIABETES DAY 4 NOVEMBER 2018 SHAPE UP
Ray Loh
BARRIERS to
EXERCISE:
T O O b u s y
TOO OLD
TOO WEAK
Physical activity is one of the most important
management and treatment methods for people
with diabetes. Yet, about 65.3% of people with
diabetes are still guilty of not participating in
regular physical activity including leisure walking
for the past three months.
The top three reasons for being sedentary were
‘No time’, ‘Too old’, and ‘Poor health’’ (Survey
findings from NHSS 2013). We often forget that
physical activity can be accumulated throughout
the day.
The benefits of physical activity on individuals’
quality-of-life including frail older adults are also
obvious. A systematic review from Labra (2015)
on physical exercise in frail older adults found
that physical exercise enhances the quality-of-life
of frail older adults as it improves walking and
balance, reducing falls, fear of falling, and overall
physical functional ability. Thus, the first hurdle to
active living is to ELIMINATE THE BARRIERS.
25SHAPE UP
Ray Loh
BARRIER 1- NO TIME
Physical activities can be accumulated throughout the day and a simple T O O b u s y ?
stretching routine does not require more than three minutes. A quick three to
five-minute workout before your shower can also be just as beneficial. A great
way to save time is to plan your social and family time together with activities
such as a trail walk with friends and colleagues, or enjoy a cycle in the park
TOO OLD?
with your family members. Shopping for groceries in the evening after dinner
can also be a good physical activity. Physical activity after eating increases
W E A K ?
TOO
metabolism and burns more calories than resting after food. Moreover, there is
no evidence showing one should not engage in physical activities immediately
after food. A good suggestion is to buy only daily requirements on each trip
to the supermarket so that you need to return for other items the next day.
BARRIER 2 - TOO OLD
Age should not limit the activities we want to do. In my recent trip to GOBI
desert race (A seven-day, 250km self-supported stage race), the oldest
participant was 75 years young. We are limited only by our own fitness.
Fitness building requires consistent training over a long period of time. For
a start, the best way is to select something that you enjoy and like to do. Do
unstructured and unplanned exercises to reduce cognitive stress. Perform only
at the intensity you are comfortable with and allow yourself to stop as and
when you are tired and not be stressed by the need to meet the intensity and
complete the distance or routine. We have seen so many giving up on exercise
after one to two months just because they believed in ‘no pain, no gain’. They
pushed themselves really hard on every workout, only to stop because they
cannot keep up. Even elite athletes suffer from burnouts with higher risk of
injury due to too many hard training sessions. Hence, select activities that you
are comfortable with. There is no evidence showing that certain exercises are
more superior than others in promoting health.
BARRIER 3 - POOR HEALTH
Exercise and physical activity could well be the best medicine as it has been
shown to improve health including cardiovascular-related diseases, metabolic
disorders and some cancers. Exercise improves cardiovascular fitness and
prevents heart diseases. Exercise has also long been used as one of the
treatments for osteoarthritis. Recently, studies show that exercise improves
recovery, quality of life and even mortality rate in cancer patients. In fact,
the lack of exercise is a major cause of chronic diseases. In other words, any
physical activity suitable for your health condition can be beneficial.
Diabetes Singapore OCT TO DEC 2018
In summary, start by taking small steps to increase your current level of physical
activity and increase slowly as you get fitter. More importantly, be consistent
and enjoy the activity you are doing.
About the author: Ray Loh is an exercise physiologist at the Sports Medicine
and Surgery Clinic, Tan Tock Seng Hospital. He has been an active volunteer
with Diabetes Singapore, giving talks and demonstrations on exercise and
workouts.
26You can also read
